Hispanic people in King County have died from COVID-19 at a rate nearly two-and-a-half times higher than that of white people, according to a new study of data released Friday showing the novel coronavirus is disproportionately affecting people of color.
Hispanic, Black and Native Hawaiian/Pacific Islander groups also have been infected and hospitalized at significantly higher rates in King County than white people, according to the analysis conducted by Public Health – Seattle & King County.
The new figures mirror national disparities in COVID-19 cases as well as a higher prevalence of other diseases for communities of color in general, public-health officials said. The analysis also underscores the effects of long-standing inequities in health care, social services, housing and other socio-economic challenges, they said.
“No one should be surprised that we’re seeing these disparities in COVID-19 disease,” said Dr. Jeff Duchin, local health officer for Seattle and King County. “It’s been an ongoing national tragedy and shame that we have communities of color throughout our country suffering disproportionate adverse health impacts from a wide variety of health conditions.”
Reasons for the disparities are still being examined, but officials said there are probably multiple contributors. Some likely causes include unequal access to diagnostic testing, fear among immigrants and refugees to seek medical treatment, and the fact that people of color are statistically more likely to work service-oriented jobs that leave them more vulnerable to virus exposure, they said.
“More communities of color, for example, live in multi-generational housing that makes it difficult to physically distance and can lead to more infections,” said Matias Valenzuela, equity director for Public Health – Seattle & King County. “Who are the essential workers, who are the people who are having to go out and work during these challenging times? The numbers are disproportionately people of color.”
The new insight into the coronavirus’ uneven impact in King County comes into focus as people of color represent an increasing percentage of the county’s COVID-19 cases.
That trend appears to reflect how King County’s outbreak unfolded, Duchin said, with most of the first cases detected among white people connected to local nursing homes. In the weeks since, more cases attributed to widespread community transmission have piled up.
“As the outbreak evolves, the percent of cases by race and ethnicity appears to be shifting, and the disparities are becoming increasingly apparent,” Duchin said.
The demographic analysis, which was published Friday on the health department’s website and will be updated, is based on totals reported in King County as of Thursday: 6,428 infections and 441 deaths. The study examines per-capita calculations for each racial and ethnic group, using the number of cases per 100,000 residents.
Washington does not currently require racial and ethnic data to be reported to public-health jurisdictions collecting information for infectious disease case reports. So, to conduct this analysis, public-health officials had to draw information from patient interviews, additional medical records and other sources.
“The other thing that’s enabled us to do this analysis is just increasing numbers of cases,” Duchin said. “…We have a large enough database now that we can do these analyses with supplemental matching of race and ethnicity data.”
The study shows that demographics of the disease in King County have changed drastically over the past six weeks.
On March 8, white people made up about 72% of the county’s cases, with Asians at 16%, Hispanic people at 6%, Black people 5% and Native Hawaiian/Pacific Islanders 1%.
As of April 26, only half the county’s cases were white people and 13% were Asians, while rates have spiked for the other groups. For Hispanic people, the proportion nearly quadrupled, to 23%. For Black people and Native Hawaiian/Pacific Islanders, it doubled – to 10% and 2%, respectively.
By comparison, 58.7% of King County’s population is white, 17.2% is Asian, 10% is Hispanic or Latinx, 6.4% is black and 0.8% is Native Hawaiian/Pacific Islander.
The disparity is particularly stark in Hispanic and Latinx communities. Hispanic people in King County are infected and hospitalized at four times the rate of white people.
“We’ve had 441 deaths in King County, and although 297 occurred among whites and 34 among Hispanics, the rate of death is higher among Hispanics,” Duchin said. “It’s about two-and-a half times higher compared to whites.”
Native Hawaiians/Pacific Islanders were infected at about four-and-a-half times the rate per capita than white people. Black people had about twice the rate of cases per capita as white people.
Case rates also are significantly higher among American Indian and Native Alaskan populations, Duchin said, but due to the small sample size from those groups so far – only 29 cases in all – the data is not statistically significant. Asians showed a similar rate of reported cases to that of white people, he said.
The analysis includes an overlay of case data on census tract maps to generally show that higher case rates exist in South Seattle and South King County, where more people of color live. Limited data by occupation and by neighborhood makes it challenging to dig deeper at this point, but officials plan to publicize more data and maps in the days ahead, Duchin said.
Coronavirus disparities are not exclusive to King County. A recent CDC study of COVID-19 data drawn from 14 states found Black people were over-represented among 580 hospitalized patients, and a New York City Health study identified death rates substantially higher among Black and Hispanic people compared to white people and Asians.
Deep-seated societal problems – from institutional racism and language barriers to inequitable access to housing, education, work and health care – are among the ongoing and complex contributors that exacerbate disproportionality in disease cases, Valenzuela said.
An estimated 70,000 to 80,000 undocumented people – who don’t qualify for federal health coverage, stimulus funding and other services – live in King County, he said.
“This is not an easy issue,” Valenzuela said. “We know that there are root causes and underlying issues that really drive the outcomes that we see across all diseases.”
To address some of the drivers of uneven case rates during the pandemic, public-health officials are meeting regularly with a community advisory group, translating public health materials in various languages and supporting state efforts to test more people and collect more data, officials said.
“But we need to do more,” Valenzuela said.
Across all racial and ethnic populations, reported cases of COVID-19 remain too high to ease up on social-distancing restrictions, Duchin said. Gov. Jay Inslee on Friday afternoon extended the state’s stay-home order through May 31, saying that public-health data — such as the number of daily confirmed cases, and the transmission rate of the virus in King County — has not yet been favorable enough.
Duchin said it’s critical to ramp up testing for everyone so we know who has the virus and can prevent more people from being infected.
“We need to get down to a much lower number of cases before relaxing,” he said. “In order to do that, we need a much better understanding of how people are becoming infected.”
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